SilverScript Plus Maryland Medicare Part D Plan
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| Medicare Rating: | |
|---|---|
| CMS Plan ID: | S5601-011 |
| CMS Plan Year: | 2021 |
| Premium: | $65.90/mo |
| Rx Deductible: | $0.00 (annual) |
| Initial Coverage: | $4130.00 |
| Mail Order: | Coming Soon! |
| Donut Hole Coverage: | Yes |
| Subsidies: | No |
| Formulary ID: | 00020222 |
| Benefit Type: | Enhanced |
SilverScript Plus is a 3.5 Star Medicare Part D Plan for Medicare Beneficiaries in Maryland
According to the Centers for Medicare and Medicaid Services (CMS), this prescription drug plan's quality is Average, and rated it 3.5 out of 5.0 stars.
These are the areas of the plan that are important to compare and review:
- Premium & Deductible: The premium is the amount you will pay monthly. Plus, many plans have an annual deductible that must be met before cost sharing begins.
- Coverage Phases: Part D plans have an initial coverage limit, followed by a coverage gap, and then catastropic coverage. Some plans offer some coverage in the gap.
- Co-pays & Co-insurance: If you have regular prescriptions, it's critical to verify that your drugs are covered and to know what you will pay at the pharmacy.
- CMS Ratings: Important measurements across 4 different areas that will help you understand how well this plan will care for you.
Cost Details
SilverScript Plus is a cost-sharing prescription drug plan (PDP). There are three distinct costs: monthly premiums, an annual deductible, and co-payments or co-insurance. The annual premium on this PDP is $790.80 ($65.90 per month), and breaks down as follows:
Low-Income Subsidy
This plan is not available to people receiving full Low Income Subsidy (LIS) benefits.
Deductible
This plan has a $0.00 deductible (annual).
A zero dollar ($0.00) deductible means you have first dollar coverage. Many Part D Plans have a deductible (up to $435 per year in 2021) that must be paid before your prescription coverage assistance kicks in.
You Pay the Premium + Deductible + Copayments
You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.
What You Pay Could Be Different
There are two situations that can change your monthly premium. If your income is low and you are accepted into the Extra Help program administered by Social Security, your premium could be lower. It's also possible that your premium could be higher due to a late entry penalty. Be sure to speak with an authorized Maryland Medicare Insurance Agent to get an exact quote for your situation.
Coverage Details
SilverScript Plus is a Enhanced PDP. At a minimum, SilverScript must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, aka, donut hole. Carriers may also offer plans that:
- are actuarially equivalent to the standard benefit; or
- are enhanced, offering benefits in addition to the standard benefit.
Typically, enhanced plans offer additional coverage during the coverage gap. If you fell into the donut hole last year, shop enhanced plans.
Initial Coverage Limit
Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the SilverScript Plus PDP, you share the cost of your prescriptions with SilverScript. You each pay your share until the amount spent at the pharmacy reaches $4130.00 (retail spending amount). That's the initial coverage limit in Maryland for plan year 2021. After that, you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.
Coverage Gap (aka, Donut Hole)
The coverage gap, or donut hole, as it is often called, is the coverage phase where you no longer receive assistance from the plan. In other words, you pay for your prescriptions out-of-pocket. How quickly you reach the coverage gap with SilverScript Plus all depends on your prescriptions. Most seniors never fall into the donut hole.
In the coverage gap phase you are responsible for the full cost of your prescription drugs up until your total out-of-pocket expenses reach $6,350 (excluding premiums and expense paid by insurance) minus a 75% discount on both brand-name prescription drugs and generics. Once you reach $6,350 in out-of-pocket expenses, you're out of the coverage gap. At this point, you automatically get catastrophic coverage through Medicare, which assures you only pay a small amount for covered drugs for the remainder of the year.
Additional Gap Coverage
SilverScript Plus offers some additional assistance in the coverage gap. See the plan's Summary of Benefits for details. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Maryland Medicaid office. You may qualify for additional assistance. The Social Security Administration's Extra Help program is another opportunity for seniors on Medicare who are not able to afford their prescriptions.
Copayment & Coinsurance Details
In addition to the monthly premium and annual deductible, the SilverScript Plus prescription drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you look up your prescriptions in the plan's formulary.
Medicare Part D Star Ratings
In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates prescription drug plans in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this SilverScript plan.
Contact SilverScript
Here's the new member contact information for SilverScript:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part D program on www.medicare.gov. For information about the SSA's Extra Help program, download the Understanding Extra Help guide.
Compare Plan Options
The average Maryland senior compares three or more plan options before making an enrollment decision.
Compatibility
SilverScript Plus can be used in conjunction with Original Medicare (Parts A and B), and all Medicare supplement plans in Maryland. It can also be used with Maryland Medicare Advantage plans, but only if the Part C plan does not include Part D.
Availability
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the SilverScript Plus prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Baltimore, Columbia, College Park, Frederick, Rockville, Gaithersburg, Bowie, Hagerstown, Annapolis, Salisbury, Laurel, Bethesda, and all other towns and cities in Maryland.
The Medicare Part D information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on .
